Childhood Obesity Treatment Interventions Research Articles

A family-based and mobile-assisted intervention for lifestyle behaviors in youths: A randomized controlled trial.

This randomized controlled trial was conducted to assess the effectiveness of a family-based and mobile-assisted lifestyle intervention in reducing weight gain among school-age children with overweight and obesity. A total of 164 school-age children with overweight or obesity and their parents were randomized to the treatment intervention (n = 82) or an attention-control group (n = 82). The treatment intervention included three face-to-face education sessions, augmented by monthly text messages sent to parents on their mobile devices. The primary outcome was child BMI-for-age z-score. Secondary outcomes included child BMI, percent body fat, and actigraphy-assessed sleep as well as parental sleep quality. Outcomes were assessed at baseline, 3, 6, and 12 months after the intervention, with treatment effects analyzed using general linear models for repeated measures. Our results showed that children in the treatment intervention group had significantly lower BMI-for-age z score, BMI, and percent body fat than did those in the control group, with an adjusted mean difference of 0.31 units (95% CI: -0.59 to -0.03; p = 0.03), 1.34 kg/m² (95% CI, -2.42 to -0.26; p = 0.01), and 3.12% (95% CI, -5.93 to -0.30; p = 0.03), respectively. No treatment effects were observed for child and parental sleep. Our findings suggest that family-based and mobile-assisted lifestyle intervention results in significant and sustained benefits to enhanced weight management for school-age children with overweight and obesity. Nurses planning and delivering childhood overweight and obesity treatment interventions should consider a family-based approach with the assistance of mobile devices.

Evaluating a 10-Week Family-Focused E-Health Healthy Lifestyle Program for School-Aged Children with Overweight or Obesity: A Randomized Controlled Trial Study Protocol.

E-Health childhood obesity treatment interventions may serve as favorable alternatives to conventional face-to-face programs. More studies are needed to evaluate the effectiveness of such interventions beyond immediately post-program completion, including exploring program features impacting effectiveness. This randomized controlled trial with a qualitative component and waitlisted control group will evaluate the effectiveness of a 10-week family-focused e-Health program for school-aged children with overweight/obesity and explore the experience of families completing the program. The primary outcome is the change in BMI z-score and will be assessed from baseline to 10 weeks. Secondary outcomes include (the change in) waist circumference, dietary intake, physical activity, quality of life, and experiences, and will be assessed at baseline, post-10 weeks, and/or immediately, 3-, 6-, and/or 12-months post-program completion. Independent t-tests will be used to compare the differences in means and analyses of variances (ANOVAs) will be conducted to investigate the impact of the program or of being waitlisted and the effect size of the program on quantitative outcome measures. Reflexive thematic analysis will be used with qualitative data. Findings from this study are expected to provide learnings to upscale conventional childhood obesity treatment services, in the hopes of curbing the rising rate of childhood obesity.

Using the RE-AIM framework to evaluate the feasibility of a parent-focused intervention targeting childhood obesity

BackgroundChildhood obesity remains a serious public health concern. Community-based childhood obesity treatment interventions have the potential to improve health behaviors and outcomes among children, but require thorough evaluation to facilitate translation of research into practice. The purpose of the current study was to determine the feasibility of a community-based, parent-focused childhood obesity intervention (“C.H.A.M.P. Families”) using the RE-AIM framework, an evaluation tool for health interventions.MethodsA single-group, non-randomized, repeated measures feasibility study was conducted. Participants (n = 16 parents/caregivers of 11 children with obesity) completed a 13-week parent-focused education intervention. The intervention consisted of three main components: (a) eight group-based (parent-only) education sessions; (b) eight home-based (family-centered) activities; and (c) two group-based follow-up support sessions for parents and children. The five dimensions of RE-AIM—reach, effectiveness, adoption, implementation, and maintenance—were assessed using various measures and data sources (e.g., child, parent/caregiver, costing, census) obtained throughout the study period. Outcome variables were measured at baseline, mid-intervention, post-intervention, and at a 6-month follow-up.ResultsOverall, the C.H.A.M.P. Families intervention reached approximately 0.09% of eligible families in London, Ontario. Despite the small number, participants were generally representative of the population from which they were drawn, and program participation rates were high (reach). Findings also suggest that involvement in the program was associated with improved health-related quality of life among children (effectiveness/individual-level maintenance). In addition, the intervention had high fidelity to protocol, attendance rates, and cost-effectiveness (implementation). Lastly, important community partnerships were established and maintained (adoption/setting-level maintenance).ConclusionsBased on a detailed and comprehensive RE-AIM evaluation, the C.H.A.M.P. Families intervention appears to be a promising parent-focused approach to the treatment of childhood obesity.Trial registrationISRCTN Registry, Study ID ISRCTN 10752416. Registered 24 April 2018.

Comparing two different family-based childhood obesity treatment programmes in a medically underserved region: Effectiveness, engagement and implementation outcomes from a randomized controlled trial.

Access to evidence- and family-based childhood obesity (FBCO) treatment interventions is a challenge, especially in underserved regions where childhood obesity disparities persist. Compare two 6-month FBCO treatment interventions, iChoose (high intensity, parent-child dyads) and Family Connections (low intensity, parents only), in one underserved US region. This unblinded, RCT reports on effectiveness and implementation outcomes. Eligibility included children ages 5-12 with BMI ≥85th percentile. Analyses included descriptive statistics and intention-to-treat Heckman treatment effect models. Enrolled children (n=139, mean age 10.1 ± 1.7 years, 30% with overweight, 70% with obesity, 45% black, 63% Medicaid) were randomly assigned to iChoose (n=70) or Family Connections (n=69). Retention rates were 63% for iChoose and 84% for Family Connection. Among children, 6-month BMI z-score changes were not statistically significant within iChoose [BMI z-score 0.03 (95% CI=-0.13, 0.19)] or Family Connections [BMI z-score 0.00 (95% CI=-0.16, 0.16)]. Likewise, parents' BMI changes were not statistically significant. No adverse events were reported. Both programmes were delivered with high fidelity (77%-100%). Engagement in core components was 25%-36% for iChoose and 52%-61% for Family Connections. Implementation costs per child with improved BMI z-score were $2841 for iChoose and $955 for Family Connections. Neither intervention yielded significant improvements in child BMI z-score or parent BMI, yet both were delivered with high fidelity. Relative to iChoose, descriptive data indicated higher retention, better engagement, and lower costs for Family Connections-suggesting that a lower intensity and parent-focused programme may better fit the intended audience's context.

Understanding Teach-Back and Teach-To-Goal Strategies Embedded in Support Calls for a Health Literacy-Sensitive Childhood Obesity Treatment Trial.

Background:Low caregiver health literacy (HL) is related to increased obesity risk for their children. Teach-Back and Teach-to-Goal (TB/TTG) are strategies that may improve comprehension of key concepts for people who have low HL but have yet to be examined in the context of childhood obesity treatment.Objective:This study evaluated TB/TTG strategies integrated within support calls delivered to caregivers as part of a 3-month childhood obesity intervention.Methods:Ninety-four caregivers (60% Black, 42% high school education or less, 53% with income ≤$29,999, and 34% low HL) with overweight/obese children age 8 to 12 years enrolled in a childhood obesity intervention. Caregiver HL was assessed at baseline using the Newest Vital Sign and caregivers were dichotomized to low and adequate HL groups for analyses. Caregivers received 6 bi-weekly support calls that alternated with in-person, family sessions. Call completion rates, comprehension of key content (correct responses on TB/TTG questions), and satisfaction with support calls were evaluated. Qualitative information on call satisfaction was gathered at the 3-month time point.Key Results:Average completion rate across all calls was 62% with a mean call time of 26 minutes (no significant difference between HL groups). Caregivers had an average score of 0.90 out of 1 when evaluating overall call comprehension by scoring TB/TTG performance. Content comprehension in calls 1, 3, and 4 was significantly higher among caregivers with adequate HL relative to low HL (p < .1). Caregivers from both HL groups felt satisfied with calls [9.1 (2.0)/10-point scale] and agreed that calls helped them learn class material better [8.1 (2.7)]. Qualitatively, caregivers provided 81 (75%) positive responses (e.g., good content) and 27 (25%) negative responses (e.g., too lengthy) regarding the support calls.Conclusions:Support calls using TB/TTG strategies were feasible, well received, and should be considered for incorporation into childhood obesity interventions. [HLRP: Health Literacy Research and Practice. 2021;5(3):e208–e217.]Plain Language Summary:This study evaluated support calls that used Teach-Back and Teach-to-Goal health literacy strategies as part of a childhood obesity treatment trial. Support calls were well accepted and facilitated comprehension of the key learning objectives in caregivers, regardless of health literacy level. These strategies should be considered for incorporation into childhood obesity treatment interventions to increase uptake of main concepts.

Assets and Challenges to Recruiting and Engaging Families in a Childhood Obesity Treatment Research Trial: Insights From Academic Partners, Community Partners, and Study Participants.

Background: There is need for the childhood obesity treatment literature to identify effective recruitment and engagement strategies for rural communities that are more likely to lack supportive infrastructure for healthy lifestyles and clinical research relative to their urban counterparts. This community case study examines recruitment and engagement strategies from a comparative effectiveness research (CER) trial of two family-based childhood obesity (FBCO) treatment interventions conducted in a medically underserved, rural region. Guided by a Community Based Participatory Research (CBPR) and systems-based approach, the primary aim was to analyze interviews from academic partners, community partners, and parent study participants for recruitment and engagement assets, challenges, and lessons learned.Methods: Over the 3-year lifespan of the study, researchers conducted 288 interviews with Community Advisory Board members (n = 14), Parent Advisory Team members (n = 7), and study participants (n = 100). Using an inductive-deductive approach, interviews were broadly coded for recruitment and engagement assets, challenges, and recommendations; analyzed for descriptive sub-coding; and organized into stakeholder/organization and participant level themes. Codes were analyzed aggregately across time and examined for differences among stakeholders and parent study participants.Results: Adherence to CBPR principles and development of strong community partnerships facilitated recruitment and engagement; however, variability in recruitment and engagement success impacted partner confidence, threatened outcome validity, and required additional resources. Specifically, assets and challenges emerged around eight key needs. Three were at the stakeholder/organization level: (1) readiness of stakeholders to conduct CBPR research, (2) development of sustainable referral protocols, and (3) development of participant engagement systems. The remaining five were at the participant level: (1) comfort and trust with research, (2) awareness and understanding of the study, (3) intervention accessibility, (4) intervention acceptability, and (5) target population readiness. Future recommendations included conducting readiness assessments and awareness campaigns, piloting and evaluating recruitment and engagement strategies, identifying participant barriers to engagement and finding a priori solutions, and fostering stakeholder leadership to develop sustainable protocols.Conclusion: Collective findings from multiple perspectives demonstrate the need for multi-leveled approaches focusing on infrastructure supports and strategies to improve stakeholder and participant awareness of, and capacity for, recruiting and engaging medically underserved, rural families in a FBCO CER trial.

A comparative effectiveness trial of two family-based childhood obesity treatment programs in a medically underserved region: Rationale, design & methods

While there is a large body of literature documenting the efficacy of family-based childhood obesity (FBCO) treatment interventions, there is little evidence that these interventions have been systematically translated into regular practice — particularly in health disparate regions. To address this research-practice gap, this project was guided by a community advisory board (CAB) and the RE-AIM planning and evaluation framework within a systems-based and community-based participatory research approach. Families with overweight or obese children between 5 and 12 years old, in the medically-underserved Dan River Region, were randomly assigned to one of two FBCO treatment programs (iChoose vs. Family Connections) delivered by local Parks & Recreation staff. Both programs have previously demonstrated clinically meaningful child BMI z-score reductions, but vary in intensity, structure, and implementation demands. Two clinical CAB partners embedded recruitment methods into their regional healthcare organization, using procedures representative to what could be used if either program was taken to scale. The primary effectiveness outcome is child BMI z-scores at 6-months, with additional assessments at 3-months and at 12-months. Secondary goals are to determine: (1) reach into the intended audience; (2) effectiveness on secondary child and parent outcomes; (3) intervention adoption by organizations and staff; (4) fidelity, cost, and capacity for intervention implementation; and (5) maintenance of individual-level changes and organizational-level sustainability. This research addresses literature gaps related to the features within clinical and community settings that could improve both child weight status and the translation of FBCO interventions into typical practice in medically-underserved communities. IdentifiersClincialtrials.gov: NCT03245775.

Treating Obesity in Latino Children: A Systematic Review of Current Interventions

Childhood obesity remains a significant public health issue in the U.S. and globally. Rates are disproportionately higher in Latinos than other ethnic groups. This review provides a qualitative synthesis of the current evidence for childhood obesity treatment interventions among Latino children. A systematic search was performed in PubMed, Web of Science and Google Scholar for articles published from September 2010 to December 2015. Randomized controlled trials treating childhood overweight/obesity in Latino children ages 5-19 focused on diet and/or physical activity (PA) behaviors were included. Of the records initially identified (n=1,592), 11 studies met the inclusionary criteria. The majority included a family-based component (n=8; 73%). Nearly half (n=5) focused on children ages 5-12, with three specifically developed for the pre-adolescence stage (ages 8-12). Nine studies acknowledged cultural tailoring, most frequently by seeking input from their intended population and utilizing bilingual delivery staff. Improvements in anthropometric measures (e.g. body mass index (BMI) z-score) were observed in 55% of the studies (n=6). Many interventions with a combined focus of diet and PA, in the form of nutrition education in a group setting and in-person activity/exercise sessions and incorporated a parent/family component reported positive anthropometric results. Three (27%) studies included a follow-up period, all of which observed a sustained decrease in BMI over time. Overall, family-based interventions focusing on both diet and PA demonstrated promising results. However, additional research incorporating a follow-up period is warranted to assess sustainability of these outcomes. Additionally, more interventions could be developed specifically for the critical developmental stage of pre-adolescence

A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions.

Effective obesity prevention and treatment interventions targeting children and their families are needed to help curb the obesity epidemic. Pediatric primary care is a promising setting for these interventions, and a growing number of studies are set in this context. This review aims to identify randomized controlled trials of pediatric primary care-based obesity interventions. A literature search of 3 databases retrieved 2947 publications, of which 2899 publications were excluded after abstract (n=2722) and full-text review (n=177). Forty-eight publications, representing 31 studies, were included in the review. Eight studies demonstrated a significant intervention effect on child weight outcomes (e.g., BMI z-score, weight-for-length percentile). Effective interventions were mainly treatment interventions, and tended to focus on multiple behaviors, contain weight management components, and include monitoring of weight-related behaviors (e.g., dietary intake, physical activity, or sedentary behaviors). Overall, results demonstrate modest support for the efficacy of obesity treatment interventions set in primary care.

Service evaluation of the GOALS family-based childhood obesity treatment intervention during the first 3 years of implementation

ObjectivesTo evaluate the impact of the GOALS (Getting Our Active Lifestyles Started) family-based childhood obesity treatment intervention during the first 3 years of implementation.DesignSingle-group repeated measures with qualitative questionnaires.SettingCommunity venues...

The use and reporting of primary and secondary outcome measures in trials evaluating childhood obesity treatment interventions

Existing systematic reviews aimed at comparing effectiveness of childhood obesity treatment interventions are limited by a lack of quality in the conduct and reporting of trials in this area. This study aimed to identify the number and types of primary and secondary outcomes used within trials of childhood obesity treatments and to determine the degree to which these trials correctly report their use of outcome measures. A systematic literature review was conducted to identify phase II (i.e. pilot and feasibility studies) and phase III (e.g. determining effectiveness) trials of childhood obesity treatments across 11 databases. Data were extracted from eligible manuscripts pertaining to the number and type of outcome measures used, in addition to details of citations provided for these measures. 145 different outcome measures were reported to be used within 200 identified eligible trial manuscripts. Citations were provided to indicate the provenance for 417 measures, but only 13% of these were correctly linked to papers describing the development and/or evaluation of measures. This study identified inconsistencies and inaccuracies in the use and reporting of outcome measures used by eligible trials. Researchers in this area are urged to consider guidelines such as CONSORT and the National Obesity Observatory Standard Evaluation Framework in the design and reporting of future trials.

Systematic review to identify and appraise outcome measures used to evaluate childhood obesity treatment interventions (CoOR): evidence of purpose, application, validity, reliability and sensitivity.

Lack of uniformity in outcome measures used in evaluations of childhood obesity treatment interventions can impede the ability to assess effectiveness and limits comparisons across trials. To identify and appraise outcome measures to produce a framework of recommended measures for use in evaluations of childhood obesity treatment interventions. Eleven electronic databases were searched between August and December 2011, including MEDLINE; MEDLINE In-Process and Other Non-Indexed Citations; EMBASE; PsycINFO; Health Management Information Consortium (HMIC); Allied and Complementary Medicine Database (AMED); Global Health, Maternity and Infant Care (all Ovid); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); Science Citation Index (SCI) [Web of Science (WoS)]; and The Cochrane Library (Wiley) - from the date of inception, with no language restrictions. This was supported by review of relevant grey literature and trial databases. Two searches were conducted to identify (1) outcome measures and corresponding citations used in published childhood obesity treatment evaluations and (2) manuscripts describing the development and/or evaluation of the outcome measures used in the childhood intervention obesity evaluations. Search 1 search strategy (review of trials) was modelled on elements of a review by Luttikhuis et al. (Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;1:CD001872). Search 2 strategy (methodology papers) was built on Terwee et al.'s search filter (Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 2009;18:1115-23). Eligible papers were appraised for quality initially by the internal project team. This was followed by an external appraisal by expert collaborators in order to agree which outcome measures should be recommended for the Childhood obesity Outcomes Review (CoOR) outcome measures framework. Three hundred and seventy-nine manuscripts describing 180 outcome measures met eligibility criteria. Appraisal of these resulted in the recommendation of 36 measures for the CoOR outcome measures framework. Recommended primary outcome measures were body mass index (BMI) and dual-energy X-ray absorptiometry (DXA). Experts did not advocate any self-reported measures where objective measurement was possible (e.g. physical activity). Physiological outcomes hold potential to be primary outcomes, as they are indicators of cardiovascular health, but without evidence of what constitutes a minimally importance difference they have remained as secondary outcomes (although the corresponding lack of evidence for BMI and DXA is acknowledged). No preference-based quality-of-life measures were identified that would enable economic evaluation via calculation of quality-adjusted life-years. Few measures reported evaluating responsiveness. Proposed recommended measures are fit for use as outcome measures within studies that evaluate childhood obesity treatment evaluations specifically. These may or may not be suitable for other study designs, and some excluded measures may be more suitable in other study designs. The CoOR outcome measures framework provides clear guidance of recommended primary and secondary outcome measures. This will enhance comparability between treatment evaluations and ensure that appropriate measures are being used. Where possible, future work should focus on modification and evaluation of existing measures rather than development of tools de nova. In addition, it is recommended that a similar outcome measures framework is produced to support evaluation of adult obesity programmes. The National Institute for Health Research Health Technology Assessment programme.

Framework of outcome measures recommended for use in the evaluation of childhood obesity treatment interventions: the CoOR framework.

Consensus is lacking in determining appropriate outcome measures for assessment of childhood obesity treatments. Inconsistency in the use and reporting of such measures impedes comparisons between treatments and limits consideration of effectiveness. This study aimed to produce a framework of recommended outcome measures: the Childhood obesity treatment evaluation Outcomes Review (CoOR) framework. A systematic review including two searches was conducted to identify (1) existing trial outcome measures and (2) manuscripts describing development/evaluation of outcome measures. Outcomes included anthropometry, diet, eating behaviours, physical activity, sedentary time/behaviour, fitness, physiology, environment, psychological well-being and health-related quality of life. Eligible measures were appraised by the internal team using a system developed from international guidelines, followed by appraisal from national external expert collaborators. A total of 25,486 papers were identified through both searches. Eligible search 1 trial papers cited 417 additional papers linked to outcome measures, of which 56 were eligible. A further 297 outcome development/evaluation papers met eligibility criteria from search 2. Combined, these described 191 outcome measures. After internal and external appraisal, 52 measures across 10 outcomes were recommended for inclusion in the CoOR framework. Application of the CoOR framework will ensure greater consistency in choosing robust outcome measures that are appropriate to population characteristics.

Results of a feasibility randomised controlled trial (RCT) for WATCH IT: a programme for obese children and adolescents.

Background In the evaluation of childhood obesity interventions, few researchers undertake a rigorous feasibility stage in which the design and procedures of the evaluation process are examined. Consequently, phase III studies often demonstrate methodological weaknesses.Purpose Our aim was to conduct a feasibility trial of the evaluation of WATCH IT, a community obesity intervention for children and adolescents. We sought to determine an achievable recruitment rate; acceptability of randomisation, assessment procedures, and dropout rate; optimal outcome measures for the definitive trial; and a robust sample size calculation.Method Our goal was to recruit 70 participants over 6 months, randomise them to intervention or control group, and retain participation for 12 months. Assessments were taken prior to randomisation and after 6 and 12 months. Procedures mirrored those intended for a full-scale trial, but multiple measures of similar outcomes were included as a means to determine those most appropriate for future research. Acceptability of the research and impact of the research on the programme were ascertained through interviewing participants and staff.Results We recruited 70 participants and found that randomisation and data collection procedures were acceptable. Self-referral (via media promotion) was more effective than professional referral. Blinding of assessors was sustained to a reasonable degree, and optimal outcome measures for a full-scale trial were identified. Estimated sample size was significantly greater than sample sized reported in published trials. There was some negative impact on the existing programme as a result of the research, a lesson for designers of future trials.Limitations We successfully recruited socially disadvantaged families, but the majority of families were of White British nationality. The composition of the participants was an added valuable lesson, suggesting that recruitment strategies to obtain a more heterogeneous ethnic sample warrant consideration in future research.Conclusions This study provided us with confidence that we can run a phase III multi-centre trial to test the effectiveness of WATCH IT. Importantly, it was invaluable in informing the design not only of that trial but also of future evaluations of childhood obesity treatment interventions.

Key stakeholders’ perspectives towards childhood obesity treatment: A qualitative study

Over the past three decades, there has been a dramatic global increase in childhood obesity. A better understanding of stakeholders' perceptions of intervention requirements could contribute to developing more effective interventions for childhood obesity. This study provides a qualitative, in-depth, analysis of stakeholders' (children, parents and health professionals) perspectives toward the efficacy of childhood obesity treatment interventions. Twenty-six stakeholders were recruited using purposive sampling; semi-structured interviews were adopted to explore stakeholders' perceptions with data analysed using a framework approach. Stakeholders concurred that treatment should be family-based incorporating physical activity, nutrition and psychological components, and be delivered in familiar environments to recipients. However, incongruence existed between stakeholders towards the sustainability of obesity treatment interventions. Parents and children reported needing ongoing support to sustain behavioural changes made during treatment, while health professionals suggested interventions should aim to create autonomous individuals who exit treatment and independently sustain behaviour change. This study provides an insight into issues of stakeholder involvement in the obesity intervention design and delivery process. To promote long-term behaviour change, there needs to be increased congruence between the delivery and receipt of childhood obesity treatment interventions. Interventions need to incorporate strategies that promote autonomous and self-regulated motivation, to enhance families' confidence in sustaining behaviour change independent of health professional support.

Treatment of Childhood Obesity: A Systematic Review

Childhood obesity trends have increased dramatically over the past three decade’s. The purpose of this quantitative systematic review is to provide an update of the evidence, illustrating the efficacy of childhood obesity treatment, considering whether treatment fidelity has been measured and/or reported and whether this related to the treatment effect size. Searches revealed 61 relevant articles published from January 2000 to 2009, including both randomized and non-randomized controlled trials of childhood and adolescent obesity treatment interventions. The review identified scant measurement and reporting of issues around treatment fidelity, an increase in the number of interventions outside of the US, (particularly across Europe) and an emergence of studies involving older children and adolescents in a range of settings. Interventions comprising a dietary, exercise, and behavioral component, supported by family involvement and delivered by trained interventionists in specialized or supervised settings, appeared to offer a potentially effective treatment for obesity. However, concern remains over study quality (particularly sample size), dropout rates and study design. Variations in outcome measures and intervention designs means generalizable conclusions cannot be easily be made. Of greater concern is the lack of consideration for treatment fidelity, which has implications for the transfer of knowledge and the reliability of interventions. Conclusions from the review include; the need for increased accuracy of reporting and objective measurement of treatment fidelity; the need for further investigation of potential cost-effective treatment options (including maintenance strategies to enhance sustainability of current interventions); and an increase in the number of longitudinal trials beyond 1 year in duration.

What is Needed to Reverse the Trends in Childhood Obesity? A Call to Action

To address the complexity of issues surrounding childhood obesity, the Society of Behavioral Medicine identified childhood obesity as a special focus of its 2007 Annual Meeting. The purpose of this paper was to provide a brief summary of the content of these sessions, promising practices that were presented, and recommendations for behavioral medicine research and practice professionals to facilitate reversing the current trends in childhood obesity. A social-ecological perspective was used to discuss views on biological and genetic perspectives, the need for policy and environmental approaches, and the need to expand the types of research and practice being conducted. Recommendations included the need to (1) conduct a broader examination of potential policy, program, and practice strategies across social ecological levels, (2) use team approaches to science that include multiple disciplines and perspectives, (3) expand the methods and metrics used to demonstrate the value of childhood obesity treatment or prevention interventions, (4) use integrated research and practice partnerships, and (5) explicitly assess the potential of intervention strategies to reduce health disparities.